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Suicide Prevention, Intervention, and Postvention Protocols

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Suicide Prevention, Intervention, and Postvention Protocols Suicide Prevention, Intervention, and Postvention Protocols: A Toolkit for Maine Schools Protocol for Suicide Prevention, Intervention, and Postvention: A Toolkit for Maine Schools INTRODUCTION TO THE TOOLKIT Suicide Prevention, Intervention, and Postvention Toolkit for Maine Schools A School’s Legal Responsibility to Provide Suicide Prevention: LD 609: An Act to Increase Suicide Awareness and Prevention in Maine Schools, was signed into law by Governor Paul LePage on April 25, 2013, following unanimous passage in the legislature. The statute requires a 1-2 hour Suicide Prevention Awareness Education training be completed by all school personnel in each school administrative unit (SAU), island, charter, CTE Region and public school that is not in a school administrative unit. It also requires all school administrative units and each island, charter, approved private and public schools that are not in a school administrative unit to have at least two staff trained in a one-day course in suicide prevention and intervention training commonly referred to in Maine as “Gatekeeper Training.” A CTE Region must have at least one school personnel member who has successfully completed Gatekeeper training on site. The second school personnel member could be either on site or the CTE Region could have a legal agreement with one of the sending schools assigned to their region. In addition, the law recommends that schools develop and implement protocols for suicide prevention and intervention. As part of a comprehensive suicide prevention and intervention program, it is essential that schools have written protocols for responding to: A. Students presenting with warning signs of suicide B. A suicide attempt C. A death by suicide. In crafting LD 609: Act to Increase Suicide Awareness and Prevention in Maine Public Schools, Maine was following an evidence-based approach to suicide prevention called the “Lifelines Program.” The Lifelines model sets out to support the development of a comprehensive safety net to identify and respond to students seen as having increased risk for suicide. The underpinnings of the Lifeline model are to develop a system of competent, confident and caring adults within the school community so that, when a student comes forward (or is brought forward) acknowledging suicide risk, the system of care is in place to address their needs and prevent a suicide act from occurring. The provision of suicide prevention awareness education to ALL school staff, the provisions of the law requiring a minimum number of trained suicide prevention Gatekeepers, and the recommendation that school districts develop and implement protocols supporting suicide prevention, intervention and postvention are all key components of the Lifelines model. The Lifelines seeks to support the development of a safety net within a school community composed of many layers and many people prepared to recognize the signs of suicide and Protocol for Suicide Prevention, Intervention, and Postvention: A Toolkit for Maine Schools intervene to get someone at risk the help they need. It recognizes that a troubled youth will approach an adult based on their comfort and fit with that adult rather than on their professional training and competence as a clinician. This includes bus drivers, custodial staff, food service personnel, teachers and ED Techs, and coaches, among others. With a basic understanding of suicide and increased comfort and confidence to intervene, these adults can act as the bridge to connect an at-risk youth to the professional help she or he needs. With a comprehensive suicide protocol in place, a school district can be assured that staff understand what they are being required. The Purpose of this Toolkit: This toolkit is designed to be used to support a school system in the development of a comprehensive suicide protocol: A. Address the issue of suicide from prevention and intervention to postvention (in the aftermath of a suicide in the school community) and demonstrating how protocols can support each component. a. Prevention: Educate school staff to be prepared to recognize and respond to signs of suicide risk. The protocols will dictate how and when this training will happen and which staff receive which training. This section will also address crisis teams and their roles in the school. b. Intervention: Promote the importance of intervention with youth at risk and connect them with the needed help. This protocol will address the process taken by staff when concerned about a student. This includes how to support the student, where to bring them for support, staff roles in a crisis, internal and external communication, referrals and follow up. c. Postvention: Information about supporting a school community after a loss to suicide. This portion of the protocol will address supporting the school community (including staff) and the families in the aftermath of a suicide death. It includes addressing communication with staff, students, outside providers and families, identifying other potentially at risk students, and difficult issues such as memorials. B. Ensure school staff are familiar with training offered in support of a comprehensive suicide program in schools. C. Provide sample policies and protocols that schools can use as a template in the development of policies and protocols that best support their community. D. Provide sample documents that may be edited and used in support of a comprehensive suicide program in schools. Protocol for Suicide Prevention, Intervention, and Postvention: A Toolkit for Maine Schools The following documents included in this toolkit are to be used in support of developing a comprehensive suicide protocol that’s inclusive of prevention, intervention, and postvention efforts. A. Comprehensive School Protocol Rubric B. Trainings offered by NAMI Maine and the Maine Suicide Prevention Program C. Report of Suicide Risk D. Safety Plan E. Guidelines for Effective Referrals F. Referral and Follow-up form G. Parent Involvement form H. Suicide Intervention Flowchart I. Suicide Postvention Flowchart Protocol for Suicide Prevention, Intervention, and Postvention: A Toolkit for Maine Schools The following rubric can be used to develop your school’s protocols. The intent is to use this rubric as a guide-using components that are most useful to your school’s needs and your community’s available resources. The below rubric is based on the most comprehensive protocol that addresses prevention intervention, and postvention. Further, it addresses issues such as staff roles, response to struggling student based on their level of risk (low, moderate, and high), internal suicide assessments, communication amongst staff, students, outside providers, and with families, referrals and follow up and documentation needs. A. Comprehensive School Protocol Rubric Yes No Partial A. Prevention Is there a written protocol for suicide prevention? If yes: Does it address the following: Staff training A1. All staff to receive basic suicide prevention awareness A2. Appropriate staff to receive Gatekeeper training A3. Clinicians, including mental health clinicians, to be trained in clinical assessment, treatment and referral A4. All trainings to be renewed every 5 years or sooner A5. New staff to receive training within 6 months of hire Staff roles and responsibilities A6. Identifies staff to serve on internal crisis team A7. Identifies staff representatives to school-wide crisis team A8. Designates a staff member to lead suicide prevention coordination A9. Designated individual is gatekeeper-trained A10. Identifies staff responsible for assessing student risk A11. Identifies staff who will follow up with students after initial assessment and referral A12. Protocol flow charts (that indicate staff roles) to be on hand for quick reference Protocol for Suicide Prevention, Intervention, and Postvention: A Toolkit for Maine Schools Yes No Partial Referral networks/resources A13. Identifies key external community resources A14. Includes names and phone numbers of community resources A15. List of external community resources is kept up-to-date A16. Identifies school resources by position and specific role A17. Provides for student education and outreach A18. Describes distribution of brochures, resources, posters, and crisis cards A19. Plan for supporting students during and after educational events (classroom or school-wide) Assessment A20. Ensures that all SBHC users complete a health risk assessment (HRA) within their first two visits to the SBHC A21. Requires additional screening if student answers affirmatively to initial HRA screening questions for depression or suicide risk A22. Specifies process and tools A23. Specifies criteria for suicide assessment using C-SSRS A24. Describes actions (triage, referral, additional care) based on results of additional screening B. Intervention Is there a written protocol for suicide intervention? IF YES: Does it address the following: Collaboration Collaboration with school staff to care for at risk students… B1. enrolled in SBHC B2. not enrolled in SBHC Assessment Protocol for Suicide Prevention, Intervention, and Postvention: A Toolkit for Maine Schools Yes No Partial Safety B3. Criteria and reasons for calling 911, police, EMS B4. Process (who, how, when) for calling 911, police, EMS B5. When a safety plan is needed B6. What a safety plan should entail B7. Inquire about the availability of lethal means in the home B8. Develop plan to remove/limit access, as appropriate B9. Other steps for ensuring student
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